Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-3621
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
1871 CHAMBLEE TUCKER RD, CHAMBLEE, GA 30341-2737
(770) 455-4699
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009108
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016460
PK
—
05
—
623765613A
—
GA
Enumeration date
12/27/2006
Last updated
07/02/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us